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Gerhard Andersson


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"ACT for Depression - a Method Comparison” A talk given by Gerhard Andersson at the Nordic ACBS Forum 2012.

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Gerhard Andersson

  1. 1. ACT for depression Gerhard Andersson, professor Linköpings Universitet and Karolinska Institutet
  2. 2. Aims • The scope of depression • The fact that most treatments seem to work (or not?) • The ACT contribution • Future challenges for a CBS of depression2
  3. 3. Depression • Widely prevalent • Higly costly • Projected by the WHO to be one of the most costly medical problems for society • More than one condition – can be chronic • Tend to relapse • Numerous theories: Biological, psychological and social.3
  4. 4. In spite of all our efforts • All serious psychological treatments appear to work as well4
  5. 5. Regardless of brand • CT as good as BT (perhaps not for more severe depression) • Format also makes little difference: Andersson, G., & Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: A meta-analysis. Cognitive Behaviour Therapy, 38, 196-205. • Cuijpers, P., van Straten, A., & Warmerdam, L. (2008). Are individual and group treatments equally effective in the treatment of depression in adults? A meta-analysis. European Journal of Psychiatry, 22, 38-51.5
  6. 6. 6
  7. 7. ACT and depression • Not much of a theory specific for depression • However the concept of experiential avoidance makes sense and so does cognitive fusion7
  8. 8. Early on • Zettle and Hayes work on depression and ”distancing” set the stage for ACT8
  9. 9. Act for depression • Behavioral analysis? Control is the problem – not the solution • Creative hopelessness • Metaphors9
  10. 10. More to it • Experiential • Monitor thoughts and beliefs • Defusion • Acceptance • Reason giving • Mindfulness • Committed action • Willingness • Ok to use BA and other CBT techniques10
  11. 11. Accept your reactions and be present, Choose a valued direction, and Take action.11
  12. 12. Evidence in favour of ACT • Zettle, R. D., & Hayes, S. C. (1987). Component and process analysis of cognitive therapy. Psychological Reports, 61, 939- 953. • Zettle, R. D., & Rains, J. C. (1989). Group cognitive and contextual therapies in treatment of depression. Journal of Clinical Psychology, 45, 436-445. • Zettle, R. D., Rains, J. C., & Hayes, S. C. (2011). Processes of change in acceptance and commitment therapy and cognitive therapy for depression: a mediation reanalysis of Zettle and Rains. Behavior Modification, 35, 265-283. • Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31, 772-799.12
  13. 13. 30 Pretreatment 25 Posttreatment 20 Follow-up 15 10 5 0 Treatment Control13
  14. 14. 25 Pretreatment 20 Posttreatment 15 Follow-up 10 5 0 Treatment ext Treatment mini Control14
  15. 15. Therapy form Rationale Therapy Active Home Technique Emotions relation therapist work Psychodynamic Yes Yes Nej No Yes Yes Humanistic Yes Yes Yes No Yes Yes Interpersonal Yes Yes Yes No Yes Yes Behavioural Yes Yes Yes Yes Yes Yes activation Cognitive Yes Yes Yes Yes Yes Yes therapy ACT Yes Yes Yes Yes Yes Yes15
  16. 16. What more is there to do? • Theory for depression • Choose target group where acceptance is key! Chronic depression, somatic comorbidity etc • Could RFT be useful as a framework? • Comparative RCTs are boring but RCTs per se are needed! • Integrate with behaviourism? • Basic science? At least some experiments16
  17. 17. Be sceptical about generic treatments! • Mindfulness classes might not be the solution17
  18. 18. Conclusions ACT is not evidence-based enough for depression But probably as good as the rest Theory and basic research needed! Do not feel tempted to apply the same approach to all